Nierenvolumetrie im Kindesalter: Genauigkeit der dreidimensionalen Sonographie im Vergleich zur konventionellen Sonographie und CT / MRT

Zusammenfassung

Studienziel: Prospektive Evaluation der Genauigkeit des drei-dimensionalen Ultraschalls (3DUS) bei der Volumetrie der kindlichen Niere im Vergleich zur CT/MRT. Methode: Bei 40 Patienten (Alter: 0 - 17 Jahre) mit einer klinisch indizierten CT/MRT des Abdomens oder des Harntrakts wurde zusätzlich ein 2D- und 3DUS inklusive Volumetrie des Nierenparenchyms durchgeführt. Der 3DUS wurde mit einem speziellen 3DUS-Gerät (Voluson 730, Kretztechnik/GE) oder einem auf Positionssensoren basierenden externen 3D-System (Echotech/GE) unter Verwendung systemeigener Volumetrieprogramme durchgeführt. Die CT/MRT-Daten wurden planimetrisch unter Verwendung der integrierten Systemsoftware volumetriert. Ein allfällig erweitertes NBKS wurde vom Gesamtnierenvolumen subtrahiert. Die mit den verschiedenen Modalitäten gemessenen Volumina wurden miteinander verglichen, das CT/MRT-Volumen diente als Referenzwert. Ergebnisse: Bei 74/77 Nieren war der 3DUS mit diagnostischer Qualität ohne Sedierung durchführbar. Der Vergleich 3DUS mit CT/MRT zeigte eine Genauigkeit von - 2,6 ± 4,4 % bei Nieren ohne Hydronephrosen (2DUS - 3,8 ± 14,7 %) und von + 4,0 ± 5,9 % bei Nieren mit Hydronephrosen (2DUS + 9,6 ± 21,3 %). Die Inter-/Intra-Auswertervariabilität betrug ± 7,3 %/ ± 5,3 %. Schlussfolgerung: Die 3DUS-Nierenvolumetrie ist auch im Kindesalter mit diagnostischer Qualität durchführbar und erlaubt eine mit der CT/MRT vergleichbare Bestimmung des Nierenparenchymvolumens.

Abstract

Purpose: Prospective evaluation of the accuracy of three-dimensional ultrasound (3DUS) to assess the renal parenchymal volume. Materials and Methods: CT, MRI, 2DUS and 3DUS were used to measure the renal volume in 40 patients (range: neonate to 17 years; mean age: 8.95 years). The 3DUS was determined with a Voluson 730 (Kretztechnik, GE) or an external 3D-system (EchoTech, GE) using electromagnetic positioning sensors attached to conventional 2DUS-equipment. The 2DUS volume was calculated with the ellipsoid equation and the 3DUS volume computed with the system integrated software. For CT and MRI, planimetric analysis was used to determine the renal parenchymal volume, whereby the dilated collecting system of a hydronephrosis was subtracted to obtain the real renal parenchymal volume. The results of 2DUS and 3DUS were compared to the results of CT and MRI, and inter- and intraobserver variabilities were calculated. Results: In 74 of 77 kidneys, the 3DUS study was of diagnostic quality. The accuracy of the 3DUS volumes compared well to the CT and MRI volumes with a mean difference of -1.8 ± 4.6 % versus a mean difference of -2.4 ± 15.4 % for 2DUS. In normal kidneys, the accuracy was -2.6 ± 4.4 % for 3DUS and -3.8 ± 14.7 % for 2DUS. In hydronephrosis, the accuracy was +4.0 ± 5.9 % and +9.6 ± 21.3 %, respectively, indicating that 3DUS is more accurate than 2DUS, particularly in kidneys with a dilated collecting system. Inter- and intraobserver variabilities were ± 7.3 % and ± 5.3 %. Conclusion: For assessing the renal parenchymal volume in children, 3DUS is feasible and comparable to CT and MRI.

Key words

Tree-dimensional ultrasound - pediatric - volume - kidney - children

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